Insight into the Status of Black & African-American Mental Health

Amanda’s contribution is part of our series honoring Black History Month.

The Black and African-American experience, like so many, cannot be generalized. Our experience is rich and complex. Although African Americans share in some experiences, each person’s experience is unique to them.

Due to the historically traumatic relationship that African Americans have had with large institutions and healthcare systems in the U.S., in addition to existing community stigma, those who struggle with mental health difficulties often fail to get support when needed. One blog cannot fully encapsulate the obstacles to treatment that exist.

However, we can open up the conversation and raise awareness amongst clinicians as we work to make strides in this area.

Before we can move forward in these efforts, we have to first understand the basis of the obstacles and resistance to treatment within the black community.

Historically, the black church has been an integral part of our community. More than just a place of worship, the church is deeply woven into black culture and family structure as a source of practical and emotional support. Faith has been a guiding light in the black community for countless generations. If you are mentally or physically ill, frustrated at your job, having marital difficulties, feeling anxious or depressed…you pray. Faith is the trust that God – not man – will see you through whatever storm you are weathering, and on the other side there will be brighter days ahead.

This thinking creates a huge obstacle for African Americans who are experiencing mental health difficulties. For many generations, those who considered seeking therapeutic aid were told instead to pray, and that God would prevail. Seeking therapeutic services outside of the church was stigmatized as showing a lack of faith in God. So as to not question God, then, people pray and suffer in silence, waiting for a miracle.

Studies show that African Americans are amongst the most religious ethnic/racial group in the U.S., and are more likely to utilize mental health support inside of the church, often relying on religiosity and spirituality to cope instead of receiving formal mental health services.

At the same time, in comparison to their white counterparts, African Americans experience higher levels of post-traumatic stress disorder (PTSD), dual diagnoses, depression and anxiety, yet only one-third of them will receive formal treatment when required.¹ ² ³

In order to shift this stigmatized way of thinking about mental health, it is vital for the church to become part of the conversation. Mental health professionals have to begin partnerships with pastors and clergy members to meet them where they are, in order to best support the congregation and community at large. Once the church begins to acknowledge and normalize mental health difficulties and promote healthy treatment options, more members of the community will likely be open to the idea of seeking out formal treatment.

While the church plays a large role, it isn’t the only institution responsible for the stigmatization of mental health services in the black community. There is a deep sense of pride and loyalty in African American families. In many families, from a very early age, there is an unspoken rule that whatever happens in your house, stays in your house. If your mother, aunt, or grandmother found out that you were talking about family business outside of the home, there would be consequences. Discussing personal and family issues with a stranger is in conflict with this deeply rooted sense of familial loyalty.

In many instances, this sense of mistrust in the outside world is warranted, stemming from a long history of public institutions overstepping boundaries into the private lives of black families. Oversharing of private family matters could jeopardize your family’s safety – or worse, cause you to lose your children. This fear is further perpetuated by historical instances of African Americans having been grossly misdiagnosed due to clinicians’ unconscious racial bias and lack of understanding of cultural differences in how symptoms may present themselves. For instance, many men of color are socially sanctioned as “angry.” What one clinician may interpret as justified anger due to inequality and systemic oppression, another may view as pathological. This can lead to two completely different diagnoses and completely different treatment plans. At its worst, this leads to over-medication and worsening of symptomatology. Such instances make many black families fear relying on services outside of the church or family for support.

Mental health stigma and fear of discrimination are just some of the reasons why African Americans are understandably discouraged from seeking treatment. Research shows that 90% of African Americans have experienced racial discrimination in some form or another, which has had a negative psychological impact on their lives.⁴

African Americans are more likely to receive higher doses of medication than their white counterparts. Additionally, a research study conducted in 2012 found that clinicians are less likely to diagnose individuals with a mood disorder when they exhibit behaviors that have been associated with stereotypical black cultural expressions of depression.⁵

After having to navigate all of these hurdles and push past our own biases, when it comes to choosing a therapist, it is natural to want to sit down and speak with someone whose experience mirrors our own. Without this feeling of shared experience, we may feel less inclined to be forthcoming in therapy out of fear of judgment. A 2015 study found that African Americans find comfort in being in treatment with racially/ethnically matched clinicians.⁶

In working with a therapist who is also a person of color, the client may feel that they don’t have to fill in the blanks to explain micro-aggressions that they may be experiencing – which aren’t always obvious, or even acknowledged, by people outside of minority populations.

There are a plethora of obstacles to treatment that exist for those in our community – lack of access to quality services, lack of disposable income to afford such services, fear of what treatment will look like, fear of what others will think…the list goes on.

Nonetheless, when working with the African American population, I recommend that clinicians lead with compassion, curiosity and deep listening. Remain conscious of biases. Be present and seek consultation when necessary.

All this said, I do see a tide shifting. Last year brought a much needed mainstream conversation shift in raising awareness and normalizing treatment for mental health within the black community.

Community advocates, politicians, artists, radio personalities and mental health professionals have been working diligently to create safe spaces and facilitate conversations about the mental health stigmas that exist in our communities, while normalizing and celebrating the benefits of seeking treatment.

I couldn’t be more excited about these conversations taking place in barber shops, beauty salons, churches, schools and radio stations. I have noticed a greater interest in and openness to therapy than I have ever seen before. The conversations that are happening amongst young professionals and amongst black families are shifting, and those in our community are becoming more open to experiencing the benefits of therapy.

The time is now to create a space where we can peel back the veil of shame that has for so long been attached to mental health challenges. The time is now to demystify the process of therapy and increase access to quality services for those in need. As long as we continue to have frank conversations and break down the stereotypes of what therapy is and who it is meant for, we will be well on our way to a process of deep community healing that is long overdue.

If you are a person of color seeking a clinician of color, I urge you to use dedicated platforms like Zencare’s Black and African American therapists search page, Therapy for Black Girls, or Therapy for Black Men. Approach the process of finding a clinician as you would approach dating or looking for a job: It is a relationship and should be treated as such. Find the one who is right for you. Ask for a 15-minute consultation before the actual session so that you can get a sense of the therapist and how they practice. It is okay to ask questions; if you are curious, ask. There is no question too big or too small.

Therapy is the greatest gift you could give to yourself. It is time to truly be “selfish” and get to know yourself on a deeper level.

References:

Davey, M. P. & Watson, M. F. (2008). Engaging African Americans in therapy: Integrating a public policy and family therapy perspective. Contemporary Family Therapy, 30(1), 31–47. doi:10.1007/s10591-007-9053-z.
Jackson, J. S., Torres, M., Caldwell, C. H., Neighbors, H. W., Nesse, R. M., Taylor, R. J., & Williams, D. R. (2004). The national survey of American life: A study of racial, ethnic and cultural influences on mental disorders and mental health. International journal of methods in psychiatric research, 13(4), 196–207. doi:10.1002/mpr.177
Jimenez, D. E., Bartels, S. J., Cardenas, V., Dhaliwal, S. S., & Alegria, M. (2012). Cultural beliefs and mental health treatment preferences of ethnically diverse older adult consumers in primary care. The American Journal of Geriatric Psychiatry, 20(6), 533–542. doi:10.1097/JGP.0b013e318227f876.
Chao, R. C. L., Longo, J., Wang, C., Dasgupta, D., & Fear, J. (2014). Perceived racism as moderator between self-esteem/ shyness and psychological distress among African Americans. Journal of Counseling and Development, 92(3), 259–269. doi:10.1002/j. 1556-6676.2014.00154.
Payne, J. (2012). Influence of race and symptom expression on clinicians’ depressive disorder identification in African American men. Journal of the Society for Social Work and Research, 3(3), 162–177. doi:10.5243/jsswr.2012.11.
Bilkins, B., Allen, A., Davey, M.P., & Davey, A. (2015). Black church leaders’ attitudes about mental health services: Role of racial discrimination. Contemporary Family Therapy, 38(2), 184-197. doi: 10.1007/s10591-015-9363-5.